Understanding heart failure and its treatments

To understand heart failure, it can be helpful to start with what it’s not.

Heart failure isn’t the same as a heart attack. It doesn’t mean the heart has stopped. It’s not necessarily sudden.

Heart failure is a chronic condition caused when the heart muscle is either weak or stiff. It can often be managed with medication, lifestyle changes and sometimes devices or surgery.

What is heart failure? 

Heart failure means that your heart is not working correctly. It's either not pumping properly, or it's stiff and only works under high pressure. As a result, parts of your body can end up holding extra fluids, leading to swelling, shortness of breath and weight gain.

Early detection and treatment of heart failure are crucial and can reduce the risk of worsening symptoms, hospitalization or sudden death. 

What are the types of heart failure? 

There are two types of heart failure:

• The heart muscle doesn’t squeeze well, referred to as “systolic” heart failure or “reduced ejection fraction.”
• The muscle is stiff and the pressure inside the heart is elevated, referred to as “diastolic” heart failure or “preserved ejection fraction.”

What are the causes of heart failure? 

The most common cause of heart failure is coronary artery disease, including heart attacks. High blood pressure and diabetes are also major risk factors for developing heart failure. Other common causes include:

• irregular heartbeat
• heart valve issues  
• toxic exposures (most commonly from alcohol and methamphetamines)
• gene mutations (that can run in families)
• some viral infections
• some chemotherapy treatments

How do I know if I have heart failure? 

Being short of breath is a common symptom of heart failure, especially during physical activity or when lying down. Other symptoms of heart failure include:

• fatigue, even with minimal effort
• swelling in the legs, ankles, feet or abdomen
• sudden weight gain
• confusion
• nausea
• loss of appetite
• difficulty sleeping

How is heart failure treated? 

The goal of heart failure treatment is to make you feel better and live longer. Your health care team can create a treatment plan that has two main goals:

• Keep the fluid in your body at a level that your heart can handle.
• Protect your heart from hormones that will weaken it over time.

Your treatment plan may include:

• taking medicines
• eating healthy foods
• getting regular exercise
• reducing stress 

Specialized heart failure treatments 

Allina Health providers work as a team to manage heart failure treatment plans. They have extensive expertise in the diagnosis and management of many specific conditions associated with heart failure.  

Heart failure technology 

State-of-the-art technologies are available to monitor and treat symptoms of heart failure. They include:

• CardioMEMS™ – a remote pulmonary artery pressure monitoring system for guiding treatment 
• Barostim™ – an implanted stimulator that reduces symptoms of heart failure by rebalancing the nervous system 
• Cardiac contractility modulation – an implanted pacemaker that stimulates the heart to help with pumping
• Cardiac resynchronization – a therapy to restore normal heartbeat rhythm, also known as biventricular pacing
• Minimally invasive valve procedures – treatments made through the skin, such as transcatheter mitral valve repair, to improve the heart’s structure 

Advanced heart failure treatments 

Treatment for patients with advanced-stage heart failure is also available. These options include:

• Left Ventricular Assist devices (LVADs) – Once considered solely a bridging solution for those waiting for a heart transplant, LVADs now function as a more permanent solution for some patients.
• Heart transplant – Allina Health’s heart transplant program, established in 1985 at Abbott Northwestern Hospital, is recognized for its world-class treatment, care and expertise.  

Why is weight important in heart failure care? 

Weight gain is a key indicator of fluid retention, which can signify that the heart is not pumping effectively. Maintaining a healthy weight and monitoring it daily can be beneficial, especially if your doctor needs to adjust your medications and other treatments. 

Finding your daily weight

Weigh yourself without clothes every morning after you use the bathroom and before you eat or drink anything. Use the same scale each day and keep a log of the readings. Call your health care provider right away if you have a weight gain of 3 pounds in a single day or 5 pounds in a week. 

When to get help for heart failure 

Call 911 or go to a hospital emergency department if you are struggling to breathe, have chest pain or are unable to think clearly. 

Call your doctor if you have a quick onset of symptoms associated with heart failure, including shortness of breath, quick weight gain or swelling in the legs or stomach. Do the same if you are unable to do regular daily activities without feeling fatigued or if it’s harder to breathe while lying down.

How long can you live with heart failure? 

Although heart failure cannot be cured, it can be managed through medications, dietary changes and physical activity. It’s possible to live a quality life for years when you follow your care team’s treatment plan, which may include these suggestions: 

Monitor fluid intake

To maintain your weight, the amount of liquids going in must equal what is coming out each day. To help with this, avoid drinking more than 2 liters of fluids a day. This includes water, milk, coffee, tea, soda, ice cream and soup.

Limit salt 

Your heart needs salt (sodium) to work right, but too much of it will cause your body to hold on to water, which can worsen heart failure. Limit daily sodium to 1,500-2,000 milligrams. Higher amounts may mean water pills won’t work effectively.

Consider these suggestions for reducing sodium in your diet:

• Avoid using salt in cooking and when eating meals.  
• Avoid high salt items, such as processed meats, pickles, olives, prepackaged meals and fast foods.
• Read food labels to find the amount of sodium in a single serving.  
• Ask your health care provider about salt substitutes. 

Take medicines as directed 

If you’re diagnosed with heart failure, you’ll likely take medicine for the rest of your life, unless your doctor gives you other directions.

Typically, patients with heart failure are on several medicines at high doses. The higher the dose, the more likely heart failure will get better.  Common medicines include:

• angiotensin receptor blockers (ARBs)
• angiotensin converting enzyme (ACE) inhibitors 
• beta blockers
• hydralazine and nitrates
• aldosterone antagonists
• sodium-glucose cotransporter 2 inhibitors (SGLT2 inhibitors)

Always carry a current list of your medications and take them as prescribed each day. Avoid over-the-counter medicines, supplements and herbal or natural products unless they are recommended by your health care provider.

Exercise regularly 

The more you exercise, the better your muscles are at pulling oxygen out of your blood — which is helpful in managing heart failure. As a start, make your goal to walk at least 30 minutes each day, then try other activities. Talk to your health care provider for more information.

If you become short of breath or develop discomfort, stop and rest. If your symptoms don’t go away with rest, call your health care provider right away.

Avoid tobacco

People who smoke are more likely to develop heart disease than those who don’t. Smoking also increases the risk of heart attack, stroke and circulation problems. Quitting all tobacco products is one of the best things you can do for your heart health.

Avoid alcohol 

Heavy, long-term drinking can lead to alcoholic cardiomyopathy — a condition where the heart muscle is damaged and can’t pump effectively. Alcohol also raises blood pressure and may interact with heart failure medications. It can also increase the risk of heart rhythm problems, particularly atrial fibrillation.

Can heart failure be reversed?

A heart failure diagnosis means you’ll live with the condition for life. You may still experience symptoms even when taking medications and closely following sodium and fluid guidelines.

If this happens, palliative care may help. It focuses on relieving symptoms and addressing emotional and spiritual concerns. Palliative care services also support you and your family in understanding the disease, exploring treatment options, and accessing community resources that help you live comfortably.

Palliative care can be provided at home, a clinic, a hospital or other types of settings. A palliative care nurse is also available by phone 24 hours a day.